Village clinic better than private centers, says doctor

Anna Bogacheva, 33, is a pediatrician at a district hospital. After getting her education in the city, she consciously moved to live and work in a village. In an interview with our colleagues at 76.RU, Anna talked about the specifics of pediatric practice in rural areas, gave advice to parents for the summer season, and explained why she doesn’t want to return to the city.

Started in the city

Anna moved to the village from Yaroslavl, where she graduated from the pediatric faculty of the medical academy in 2017. She now lives and works in the neighboring Kostroma Oblast.

“I managed to work for about a year at a children’s clinic, where I went straight after university after getting accredited. That clinic was the one I went to as a child. There was a good team; I could easily ask for help. There was a good head doctor who gave me a start in work—she trained me in practice. Now when I visit, I often drop by to say hello,” the doctor shares.

The village where the doctor lives has a community center, a feldsher-midwife station (rural health post), a school, a kindergarten, a post office, and a library. She moved here after getting married.

“While I was on maternity leave, I was still registered in the city. But even before, I was drawn to the village. During maternity leave, I got used to it, and after it I came here—to the district hospital as a district pediatrician. I joined through the Zemsky Doctor program (rural doctor recruitment program) and received a payout. I still work here. The team welcomed me well, and the chief pediatrician of the district helped,” she says.

Anna drives to work in a neighboring village five kilometers from her home.

How rural work differs from city clinic

According to the pediatrician, the difference in work is significant. It concerns both the schedule and the workload. So, each doctor in the district hospital is essentially a generalist. For example, an ophthalmologist at the hospital sees everyone: both children and adults.

“At first, it was hard to adapt. For example, in the countryside there is a shortage of pediatric specialists. Not long ago, a treatment and diagnostic center was opened at the regional hospital; they have specialists, but not many appointments—not everyone can even get there. So the pediatrician ends up being like a specialist for everything, except for those who are at the hospital. If additional examination or hospitalization is needed, then of course we refer to the regional center,” she shared.

At the district hospital where Anna works, there are four pediatricians on staff. Three of them manage districts and see patients, while one supervises schools.

Among other features, the doctor highlights the work schedule—essentially 24/7.

Pediatricians make house calls. And here, too, there are differences between city and village.

“In the city, there are more calls, but the district is small. For example, there could be three calls in one entrance. But here, the spread can be quite large—kilometers of travel. Daytime cars help—when they are free, we can use them,” added Anna.

“People just can’t get there”

A feature that city residents probably never think about—how to make it to an appointment at the scheduled time. You get an appointment slip and you go. In the village, it’s different.

“There are morning or evening appointments. But not everyone can come in the evening. We have buses that run from distant villages twice a day. So parents can only bring their child in the morning and then pick them up at lunch or evening. So at those times, even if my appointment hasn’t started yet, I still see them because I understand they simply can’t come at another time. They have to travel from a faraway village. It’s not like in cities—strictly on time. I see everyone,” said pediatrician Anna Bogacheva.

What problems parents come with

In this sense, there is no difference between city dwellers and villagers: people get sick about the same.

“Illnesses are no different from city ones. There’s seasonal flu, and we have it too. September, October, November are ARVI with cough, runny nose, and fever. Parents may come with children from villages referred by feldshers, because due to their limited capabilities, they are not competent in some issues and send them to our district hospital,” explained Anna.

Why the young doctor loves her job

On this point, Anna opened up. The pediatrician adores her profession and seems to throw herself into it wholeheartedly. At the same time, the heroine is herself a mother of two children.

“I love it for the feedback. Most patients are very grateful and understanding. The children are wonderful. For those who are not very compliant during exams, I give out stickers; I buy them specially. As a kind of incentive for those who don’t want to let me listen or show their throat,” says Anna Bogacheva about pediatricians’ tricks.

Probably not everyone would enjoy listening to other people’s problems. But Anna sees it as a plus of her work—helping to relieve emotional stress.

“Sometimes you need to be a bit of a psychologist. Postpartum depression hasn’t been canceled, for example. Mothers worry about everything and nothing, they don’t understand how to cope with the child. So you calm them down, explain the features of a newborn, that many physiological conditions are not scary but a variant of the norm,” explains the pediatrician.

She also explained why it’s important not just to treat but to build trusting relationships with patients.

“As my nurse used to say, our common task is to raise your healthy children. Doctors give recommendations, but we don’t know if they are followed at home. Trusting relationships between doctor and patient are important,” emphasized Anna.

A scary case with a newborn

Anna also told about a rare case she encountered in her practice. In her first year working at a rural hospital, on a day off, she received a call to a newborn. The condition was frightening: vomiting, the baby rolling its eyes.

“The baby was born normal and healthy. They were discharged home. The parents and I kept in touch, exchanged contacts. They wrote to me that something was wrong with the child: vomiting, rolling eyes. The father came to pick me up. On the spot, I realized something was wrong with the infant, but I couldn’t say exactly what. I insisted on hospitalization. In the regional center, they examined and found out that an intraventricular hemorrhage had occurred in the brain,” recalls the pediatrician.

According to the doctor, this condition is extremely dangerous, even fatal.

Intraventricular hemorrhage is an excessive accumulation of blood in the brain cavities due to rupture of immature vessels. The clinical picture depends on the stage of the disease: the mildest may be asymptomatic. In more severe cases, the hemorrhage is followed by multiple manifestations—from strabismus to respiratory depression.

“The condition was dangerous; few survive it. They were treated for a long time. The child was given a disability, but he is in good condition now. A good boy. We still have warm relations with the family. Great parents, a very strong mother, how much she went through. I remember how many tears I shed, let alone them… When a child is in intensive care, they don’t let you in. But thank God, the doctors took over, operated. Now he is compensated. The main thing is that he is alive. Yes, with a disability, but he runs, jumps, goes to kindergarten.”

Why she doesn’t want to return to the city

Anna has come to love both the rural life with its atmosphere—her own garden, nature around, and open spaces—and the work at the district hospital. As she notes, earnings in the hinterland are similar to a doctor’s income in the city.

“Of course, we communicate with colleagues from the city, see each other at conferences. I observe their work. However, at our district hospital, they did a gorgeous renovation with hand-painted walls in the children’s consultation room—it was sponsored by a local jewelry company. And now it’s no worse, even better, than in private centers. Clean, tidy, there is a mother-and-child room with a changing table. Waiting time with children is comfortable because there are special playhouses with everything. Our children’s consultation is like Narnia—a separate world. There is a TV to watch cartoons, a good restroom. I go to work with great pleasure.”

Advice to parents for the summer season

In conclusion, the pediatrician gave recommendations to moms and dads on what to pay special attention to in children’s health.

“I would advise paying attention to several issues. First is ticks; there are many of them. Especially near water bodies, which the countryside is rich in. Always check yourself and your children. In practice, there was a case where a tick bit a newborn on the head. As it turned out, a cat brought it. Thank God it turned out to be uninfected. I was shocked that a child who is just lying down had a tick.”

The doctor highlighted other dangers to be encountered in warm months:

• intestinal infections and rotavirus. Summer is the season of fresh berries and fruits, and with it the risk of food poisoning increases;
• tonsillitis due to excessive ice cream. The child gets hypothermia, making it easier for viruses to attach;
• heat strokes—wherever children are, they should wear head coverings;
• injuries: bicycles and electric scooters are a particular threat. Children don’t know traffic rules, they don’t dismount at crosswalks, which is very dangerous;
• stress in teenagers during exam periods, against which diseases also worsen.

“Children in their first years of life should not be left in direct sunlight. Sometimes a child is covered, but one leg sticks out from under the hood and gets burned. There are also sun allergies,” concluded the doctor.